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Well, we sent to see Megan last night, and she was very doped up, and not really aware we were there. We have feared the worse all night, and the local vets had a nurse sleep with her all night, so that someone was with her all the way. We have just been in to see her this afternoon, and whilst a lot more perky than last night, there are other things now to take into consideration. Her new tests show her Bilriubin up to an horrendous 5521, it just seems to be going up and up. Her jaundice has gone, but she has a slight anemia now, and her breathing is quite heavy. She was very happy to see us, and was very frustrated that she couldnt have cuddles initially, so we eventually took her out of the cage and sat with her laid on our knees and she calmed down a lot, but was making quite a few squeeking sounds, which isn't megan at all. It was time for her pain killers, so they gave her an injection through the drip, and she immediately zoned out. We made a note of the pain killer they are using which is called comfortan, because we were so surprised at how fast it worked. Having come home we looked it up and it clearly says that it must not be used on dogs with liver problems. We have put a call into the specialist vet to ask her if she was aware they were using this, and also if there is an alternative, and we also have just spoken to the local vet who say they are aware of its suggested uses, but they wanted to ensure that she was pain free, and under the circumstances they felt it was the one to use. So this has of course worried us.
Her liver biopsy did not come back yesterday, but we have had a message from the specialist vet to say that they will definately be with us by the end of the evening. I know the decision for Megans future really lies with the results. I just feel she is on a knife edge right now - no matter what is done, her bilirubin results keeping going up, and I feel the local vet is trying to get us ready for what they feel is inevitable. We will only do whatever is right for Megan, but I do want to give her a good chance because we believe that she is fighting. Am I wrong to question the use of the Comfortan? could it be doing more harm than good?
Thank you to anyone reading.
Lynne x

Sorry, my apologies its not her bilirubin at 5521, my husband says it was the ALP. Whatever it is, it was flipping high. Sorry, my head really is all over the place at the moment. I'll double check these and put the right totals up once the specialst vet has rung.
Lynne

Yes, Lynne, you are correct to question the use of this drug. Yes, it could be very harmful. Do you have copies of her blood chemistry reports - not just a verbal report? As the owner, I'd want to see the series of reports. Why is she on a pain-killer? Has she been or is she currently in pain? What kind of pain and what do they think is the source of the pain? This is difficult to say, but I wonder if the local vet has given up. This is where a specialist is important.

Your decision would be based on not just the diagnosis (or differential diagnoses if that is what you get - and this means a list of all of the possible things that might be wrong) but also on the treatment options, her quality of life, and the response to treatment options assuming that there are things that you can try to help her get well. Also, be aware that biopsy results can often be inconclusive so these results may not give you a clear direction on what to do.

Sky high alk phos (a liver enzyme) is not as alarming to me as her bilirubin, albumin and hematocrit. Those values will give more information about how serious this is.

Following this and can only say you are doing great work on staying on top of this and Pat is as so often, very helpfully right in there with very informed advice. I can only hope you get Megan home before long.

Hi Pat,
Thank you for replying so quickly. We are going back in about 20 minutes, so I am going to ask for a copy of her last tests so that I can let you see exactly what they are. they talk them through with us, and each time I try to remember, but there is so much else to take in, all I hear is very high, and getting higher in some cases. We are still waiting for the specialist vet to call us, but in the mean time the local vet has called and said their head guy is going to ring them to chase those results and is also going to ask them about the Comfortan. Apart from obviously having the seizure when we rushed her in yesterday morning, megan gave no signs of being in pain, so we shall ask about that tonight too. She was very vocal this afternoon, and her breathing was laboured and deep - both of which seem to be side effects of the comfortant. Still no signs of the report yet either.
We will report back as soon as we get back home.

Thank you Karlin, I very much appreciate your thoughts, and I more than welcome Pats replies - so often you can be railroaded down an alley without knowing there was another route, and for that we are especially grateful. We are now talking to the specialist vet on the phone as I type (husband is talking, I am typing). He isn't saying very much, and the specialist is doing all the talking, so I shall have to add another post very shortly.

So sorry to hear your girl is so ill.
Just over a year ago,our oldest cavalier had hepatic encephalopathy.Pat was a wonderful support to us,all through Christmas,as we fought to save her.She knew immediately what it was...
Once she comes through her biopsy,hopefully she will improve on a liver support diet,you can either prepare your own diet for her,or Royal canin do a prescription hepatic support food.In our girl's case,she had liver cancer which had spread to her lymph nodes,the surgeons clearly saw this as they decided to do the biopsy via a small incision and get a good look inside.You really do need to push to get the biopsy results,and I hope you have some encouraging news.
If she is fitting because of the encephalopathy,they really need to stop dosing her with drugs,in order to prevent further liver damage.
Sins

Sharing my sofa with Holly, Ivy,Lilly and Hazy.. and never forgetting our beautiful Daisy who reached the bridge too soon.

Ok, so, not good news. I am writing this all down, and then we are heading off to the vets. We will not be making any decisions until tomorrow. The biopsy result was worrying to poor. the small sections of her liver lobes are non functional, and have probably never been functional from birth. the large lobe has severe colongitus (excuse spelling) and a lot of fybrosis which specialist vet says indicates late stage liver disease. She believes that the antibiotics that she is on are the best ones to try and help manage the situation, and the lactulose. She suggests that we see how she manages over the next 24 - 48 hours, her recommendation is to reduce the use of the comfortan, in terms of dose and frequency, but both her and her team think the mix of meds is the right one for megan as she is, but really she was just going around in circles about how she is so sorry, etc., and that she agrees with the local vets use of meds under the circumstances. She said that we should consider Megans wellbeing when making our decision, which of course we would.
I just don't know anything now really. We are going up to the vets for the last appointment at 7:15 to see the head vet there, and then to spend some time with megan. I doesnt seem that there is a way forward other than the inevitable.
Lynne.

Hi Pat,
We are going back in about 20 minutes, so I am going to ask for a copy of her last tests so that I can let you see exactly what they are. they talk them through with us, and each time I try to remember, but there is so much else to take in, all I hear is very high, and getting higher in some cases. Apart from obviously having the seizure when we rushed her in yesterday morning, megan gave no signs of being in pain, so we shall ask about that tonight too. She was very vocal this afternoon, and her breathing was laboured and deep - both of which seem to be side effects of the comfortant. Still no signs of the report yet either.
We will report back as soon as we get back home.

I always get copies of all reports, and take notes about what my vets are telling me. I often type up questions or observations and give a written copy, and vets have told me that is helpful. It's also great to have an "at home chart" so that in an emergency you don't have to rely on your memory and can just give the file to the ER vet.

I truly don't understand why they have given the strong analgesic/pre-anesthetic - that to me is a signal that they have given up, which causes great concern. I'd want to see the blood chem reports before and after she had this drug - and all of the reports since the beginning of these problems so that I could track the values in response to what was going on at the time.

What terrible circumstances, I'm so sorry to hear that Megan is struggling so much.

If I could offer a suggestion, take pictures of the blood chemistry reports (if you have an iPhone I recommend the Scanner Mini app, instead of the regular camera). If you can post those here you won't have to try to keep clear which are which, and there are a few people who will be able to help you sort out which numbers are the most important.